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'The prevailing culture is quite rageful and assaults the NHS'


Nursing is a funny old muffin. It’s spent 20-odd years turning itself into a profession, edging along the park bench of jobs towards the doctors and the teachers, and away from the oddly dressed vocations like the performance artist or nun. Yet somehow it never fully arrives, does it?

Changes have seen the abandonment of hats and the embracing of degrees. We now have career paths, grading systems, specialists, consultants and professors. And yet, sometimes old habits pop up. Maybe some nurses still find certain things harder to do than their professional brothers and sisters.

One of the obvious ones is striking. Another is to fully and vocally engage in the politics of the health service. And a third is the criticism of patients.

Of course, I don’t mean individual patients; I’m not suggesting the modern nurse might welcome a new admission with the words, “let’s get you out of those clothes, Mrs Smith, after all, they are horrible. Leave your hat on - if I had hair like that, I would.” I mean more of a cultural critique, if you like, referring to the insatiable hordes.

It seems there are two elements to the ongoing crisis affecting our overflowing accident and emergency departments. On the one hand, it reflects a systematic long-term disinvestment. I know economic fetishists say that this is because we can’t afford to fund healthcare any more, but they are ninnies. We remain a wealthy nation - we just choose to organise ourselves in a way in which our wealth is collected by very rich people rather than by tax collectors.

So it is remiss to talk about strain on services without commenting on the lack of investment - both financial and moral; knowingly putting stress on nurses and doctors is a moral choice by politicians.

However, there is another element to A&E departments being overrun, which has something to do with people using them when they don’t really need to. People turn up because they want antibiotics, or a hug, or because they have just split up with their boyfriend or can’t find Nando’s. People who, for some reason, want rather than require immediate medical attention and think that it is okay.

This reveals an interesting paradox, doesn’t it? We have a popular body politic that considers taxation to be a bad thing, but an accompanying culture that imagines whatever resources are available are limitless when applied to “me”. We are, in effect, saying “I won’t pay extra tax to fund the NHS but I will use whatever services I fancy when I want, because that is my ‘right’”.

I wonder how we constructed that sensibility, or what emotions underpin it. Given that we have established that you are all too nice to wonder, I will go out on a limb here - I think it is quite aggressive and it might constitute something rageful: assaulting the NHS. I also think - and I realise this is not an emotion and I really hate using this word - it is stupidity. At the very least, we have failed to educate patients in how to value and use a communal resource, and I don’t think nurses feel able to say that.

I also suspect it might have something to do with how we perceive our “rights”. We seem to talk about our rights a lot these days. What we don’t talk about so much is other people’s rights.

I think the way we value and treat our public services shows us our collective character. I worry that that character is cross, self-absorbed and poorly. That’s no way to be, is it?


Readers' comments (2)

  • michael stone

    'We remain a wealthy nation - we just choose to organise ourselves in a way in which our wealth is collected by very rich people rather than by tax collectors.'

    Beautiful !

    As nobody else has had a go yet, and I like Mark's pieces, I'll stick my oar in.

    I'm fairly old - early 60s - and I don't really have much idea how today's younger adults 'think'. But I think Thatcher et al promoted a sort of 'me first' culture in the 1980s, and I gather that an 'everything now' attitude is much more common these days, than it was when my own parents (young adults at the time of WW2) were 'in their prime'. Also, there is much more 'protection of the young' than when I was a kid in the 1960s - how many children walk to school these days, how many 'are as free to roam and play' as children were 50 years ago ?

    So do some of the people who turn up at A&E, do that because they have been 'trained' to require 'an expert opinion' instead of using their own judgement - how many younger people 'smell food and decide if it is still okay' instead of blindly following 'use by' dates on labels ?

    So I can see why Mark is so 'grumpy' about this - but although I might agree with Mark that 'I worry that that character is cross, self-absorbed and poorly', whose fault is it [that things seem to have changed] ?

    There is, to my mind, one really major difference between the young adults of today, and the young adults who were around when the NHS was first established: people who were 20 and older in the late 1940s, had just lived through world war two, and did that 'hugely influence perspective' ? Even the older people who lived through WW2, are now dying out.

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  • I very much agree with Mark. I have worked in the NHS and now work in Australia in Primary Care. Here there is a bit of a 2 tier system with Private Healthcare playing a much bigger role, and those who have health insurance, use it and expect very good service. Having said that, there is also the wide body of total expectation that people will be seen when they want, without having to do the boring things like wait for appointments or pay for their visits in private billing medical centres - so they go to A & E, get impatient, bad tempered and of course it can only be because the staff either don't really know what they are doing or are too busy chatting and having coffee. A patient I triaged only 10 mins ago complained they had a fall 3 days ago, did nothing about it and now at 4:45pm wants to see a Dr because they are in pain and their foot is swollen - for a centre that closes at 5pm. They were very disgruntled that we weren't staying open late to accommodate them. They are not a registered patient here. This is quite typical. Most patients are very grateful for what you do for them but seem to think once they have told you their issues, their personal responsibility is removed and now its over to you to solve their problems for them. You are causing more pain by not seeing them straight away, you have allowed the wound to get infected, because of you, they are inconvenienced. There is a definite Me culture and it seems incipid. With the advance in technology, people expect everything now.

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